Evaluation of Hepatitis B Immunization Program for Children in Gaza Governorates, Palestine, 2007

Shehda Khalil Ali Barhoum
شهدة خليل علي برهوم
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Al-Quds University
Hepatitis B virus (HBV) is one of the major diseases of mankind, a silent, unnoticed killer destroying or stimulating development of liver cancer in someone who thinks he is completely well. Vaccination is the most successful tool for HBV prevention, over 90% of susceptible children develop Anti-HBs (≥10 mIu/ml) following three doses of vaccine, approximately 5 to 15% of infants fail to produce protective levels of anti-HBs (<10 mIu/ml). This study is based on a sero-survey for Measles Rubella and HBV conducted in year,2003, carried out among Palestinian children aged 18-30 months old. HBV Level shows that, the non-respondent to HB vaccination child numbers were, 66 in West Bank and 63 in Gaza Governorates. The purpose is to evaluate HB immunization program for children in Gaza governorates, Palestine, 2007 and to study the associated factors lead to a poor response for HB vaccination among vaccinated children in year 2001 in Gaza Governorates, Palestine. The study population includes all (63) identified as nonrespondents to HB vaccine and (126) respondents as controls, carried on Governmental and UNRWA public health centers in Gaza Governorates. The study is a quantitative, case-control, retrospective. The vaccine non-respondents are coming from the five Gaza governorates. For each "non-respondent" case, two "respondent" controls selected by systematic random sampling method, from the same sex and local health center. Closed ended questionnaire filled from vaccination files. For non-recorded data (15.9%), child mother interviewed face-to-face and supported by immunization cards. This step is followed by designing an entry model using computer software SPSS, where data was entered and analyzed. Several factors increase the risk of non- response to HB vaccination studied and classified into Socio-demographic factors: residency, sex, mother education level and type of immunization place, were all found not statically significant on non-response to HB vaccination; additionally response to HB vaccination did not correlated with family size. Health status factors: Birth weight, history of hospitalization before vaccination, history of infection, nutrition status, feeding during immunization and suffering from adverse event after vaccine, none is statically significant. Immunization factors: all children in the study received three doses of vaccination; the manufacture and difference of lot numbers of vaccines (1st, 2nd & 3ed) doses were not statistically significant. In addition, response to HB vaccination not correlated with the interval from birth to first vaccine, interval between first and second dose, interval between second and third dose. While the interval between last vaccination dose and Blood sample testing date was found to be negatively correlated and statically significant (P-value= 0.024). Environmental factors, the change of seasons of (1st, 2nd & 3ed) vaccinations and the presence of a sewage net in area was not statistically significant. Tentatively, this study could be a model to define further risks factors, which are not included in this study, and may affect non-response to HB vaccination in developing community as Gaza Governorates. Such study and similar studies will help in institute successful intervention program to reduce the non- respondent percentage of infants to HB vaccination in Gaza, Palestine and other similar countries